A patient with huge ectopic calcification that was diminished after conversion to prolonged hemodialysis

Abstract

A 35-year-old man had undergone maintenance hemodialysis therapy since 1998, which however was switched to peritoneal dialysis because of blood access problems in 2000. He developed huge ectopic calcifications in the right shoulder and left buttock in December 2003 due to hyperphosphatemia and calcium-phosphate product above 90 (mg/dL)². To improve hyperphosphatemia and ectopic calcifications, the dialysis modality was converted to hemodialysis in October 2004. However, the ectopic calcifications progressively worsened. He was referred to our hospital for kidney transplantation in February 2005. However, 67Ga scintigraphy showed uptake in the right shoulder and left buttock. Furthermore, methicillin-resistant Staphylococcus aureus was detected from the left buttock incision, which necessitated the delay for renal transplantation. Because antibiotic therapy had no effect and the calcification had worsened further, he was treated by weekly 22-hour long hemodialysis sessions. After conversion to prolonged hemodialysis, calcium-phosphate product was controlled and ectopic calcifications were reduced. Finally, he received a renal transplant from his mother on 14 January 2009. This is the first case of kidney transplantation after conversion to prolonged hemodialysis for huge ectopic calcification. The huge ectopic calcifications were difficult to treat, however, prolonged hemodialysis sessions were useful in the management of this case.